Evercare

May 23, 2008

  1. jerrykramer64fan
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    jerrykramer64fan Super Genius

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    I just took the training for this product because an agent that works with me ran into a senior that might be able to use this. He is 82 and just has Med A & B. He has HBP and a few other things. Had cancer a few years back and might be getting it again. His medical bills are going to be sky high and his daughter is trying to get him some coverage. Any thoughts?

    :GEEK:
     
  2. GreenSky
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    GreenSky Guru

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    If he doesn't have a Med Supp (and it sounds like he doesn't) and his docs are in network, and the hosptial is in network, then it may be the right thing to do.

    The product, at least in California (HMO), is good but remember as with all managed care he might be limited somewhat in his access to care.

    Rick
     
    GreenSky, May 23, 2008
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  3. retread
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    retread Guru

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    I don't know what state you are in, but if I were you, I would first make sure the county he is in, is in the service area. Here in Kansas, Evercare only serves 2 counties of the whole state. Because of that, the network is small, making other SNPs more attractive. Over in Missouri, they are concentrated in other metro areas than KC, so there is no local presence for KC. Where they have a good network, they are a good choice.
     
    retread, May 23, 2008
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  4. fostever
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    fostever Guru

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    Personally I think their inpatient hospital benefit is pathetic. $175 co-pay for 20 days. On that basis alone I would not recommend it. Wellcare if it is available has a much lower OOP. It depends where you are located and what other MA plans are available. If you can get them some decent discounts for the meds he's taking and some outpatient coverage to offset current bills and the doctor is in the network it might help. I realize during lock-in the choices can be limited to a cronic care plan depending on the situation.
     
    fostever, May 23, 2008
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  5. mr0bunghole
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    mr0bunghole New Member

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    Evercare sells Special Needs Plans (SNPs) and theirs specifically are for chronic health problem, institutionalized or dual-eligible people. Based upon this 82 year old he would probably qualify for the first option. However, chronic health SNPs have a laundry list of ailments that an individual must already have in order to be eligible for the plan.
     
  6. fostever
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    fostever Guru

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    I sat with a client yesterday to see if I could get her in the MA plan that her other family members are in. My MA has a plan that she could join by having HBP,HC, or diabetes. She had none so I am in the process of helping her apply for our state's prescription discount plan to create an SEP. Medcare showed that she was being enrolled in part "D" effective 6/01/08. I checked Medicare .gov and it claims she will have Evercare. I wonder how these agents are getting people in these plans that have NO health problems?
     
    fostever, May 23, 2008
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  7. jerrykramer64fan
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    jerrykramer64fan Super Genius

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    No med sup, no pdp, no VA. My first impression is that early on after he hit Medicare, he was healthy and figured A & B were enough. Famous last words I guess. It never ceases to amaze me that people forget the definition of the word "Insurance". When they complain that insurance companies only want healthy people and won't take the sick, or they say that they are so healthy they will never get their monies worth from their health insurance, I usually respond by asking them if they crash their car into a wall once a month to get their moneys worth, and if they did, how long would they have coverage. Usually shuts them up when they think about it. People tend to look for health insurance only after they get sick. I'll check on his doctors. Thanks for the input.

    :yes:
     
  8. jerrykramer64fan
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    jerrykramer64fan Super Genius

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    I'm in WI. I believe Wellcare put a freeze on their Duet SNP, and we can not enroll anymore people in it. I use Wellcare a lot for MA's, but never got into the SNP's.
     
  9. retread
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    retread Guru

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    If your client qualifies for the SPAP, then she may be on Medicaid. If that is the case, she can qualify for the dual eligible SNP and not have to have a chronic illness.
     
    retread, May 23, 2008
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  10. retread
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    retread Guru

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    Good comeback!! I love it!
     
    retread, May 23, 2008
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